Mental illness in the college student

Along with millions of Americans, I’ve tried to comprehend the tragic shootings in Tucson, reaching deep within myself to find compassion for a young man who has forever changed the world for himself and so many others through his actions.

For those of us who assess, diagnose and treat college students struggling with mental illness while trying to succeed in their academic pursuits, the events leading up to his impulsive killings were chilling indeed.  As a college health physician, I and my colleagues all have known progressively destabilizing students like Jared, have tried valiantly to keep them in school while coordinating complex therapy and medical treatment and we all have, at times, failed to turn things around.

As I have tried to remind myself over two decades of this work, the primary mission of an institution of higher learning is not to be a residential psychiatric treatment center, but this level of care often is expected by students and their families, and this week, this opinion was echoed by a chorus of media pundits, bloggers and commenters.  They say: how could the college have forced this student out of school when he was clearly so ill?  Didn’t the college understand that removing him from school would make things worse and remove him from daily monitoring of his behavior?  Wasn’t there a way to compel him to get psychiatric assessment and treatment?

From being on the mental health treatment side of those questions,  there are times when the student simply can’t remain in the classroom, yet won’t cooperate with seeing a psychiatrist, and is not impaired enough for the state to go through commitment proceedings.  They are truly lost–no longer appropriate for school, angry about being suspended, but within their civil rights to remain unevaluated and untreated.

Most students I have seen with disruptive or impairing mental illness symptoms agree to take a medical withdrawal to invest full time in their recovery for a few months or a year, or occasionally they choose entirely on their own to drop out, never to return.  Very few are so gravely disabled they are committed to mental hospitals or end up in jail because of extreme behaviors that harm others.  Tragically, some commit suicide, most without ever seeking help.  Rarely, they become too disruptive or dangerous to self or others so they have to be suspended from school until they can demonstrate stability and fitness to return.  One in a million will kill others.   Those of us who see mentally ill students every day understand all too well what is at stake.  I have had numerous students and families tell me that the routine of school is the only thing that will keep things from destabilizing more.  It is the only place mental health treatment is easily available and affordable.  It will surely cause increased stress for the student to leave the academic pressure cooker, getting behind in their course sequence, delaying graduation and a career,  even if that student is not attending class, not completing assignments, not making progress, possibly exhibiting disruptive or threatening behavior.   Too often, there is simply no stable home for the student to return to for treatment and recovery.   Much of our time is assisting students in making that transition to care outside of the campus environment as there may not be family members who can help.

Young adult students are living with more academic and social stress than they’ve ever known before at a vulnerable time in their development:  their support system is changing with families broken and fragmented, their identities are still forming, their values and moral underpinnings are continually being challenged, and their brains are still developing.   Add to that mix the ubiquitous and noxious presence of alcohol and recreational drugs that exacerbate or even trigger mental illness, and it is not surprising that some college students find they cannot cope with life.  The epidemic of depression, suicidal ideation and behavior among college students is a crushing reality.  I have had to personally go to apartments where I suspect a “no show for an appointment” student is holed up, not reaching out for help, planning to commit suicide, and talked them into agreeing to a psychiatric inpatient hospitalization to keep them safe.

Despite deep budget cuts, many institutions of higher learning are still doing everything possible to address exploding student mental health needs, and must handle crises twenty four hours a day.  Psychiatric prescribing is standard student health care on many campuses for increasingly complex students as there is rarely affordable access to mental health care off campus in a timely fashion.   Some students arrive at the University on five or six psychiatric medications considered crucial to their stability–some families make the decision about which college to attend based on the quality of the mental health care available on campus.  It takes seasoned expertise to help a student manage that kind of pharmacopeia and still stay awake in class, sleep soundly at night, and maintain balance in their social life.  We are doing our best to help keep these students in school, even when their behavior seems odd, or their thinking is tangential, or they struggle to keep both feet in every day reality.

College is a time for learning–that is something we can all agree on.  It is also our responsibility to keep the academic environment safe, free from threats, while supporting students with mental illness who need help to learn to live and let live.   When that support is not sufficient, when a student is unable to “learn” effectively due to the degree and severity of their illness, or their symptoms are compromising the learning of other students,  they must take a break to work full time on learning how to manage their illness.   I have seen many return after that break and be successful in completing their degree.  Even better than the diploma earned is the knowledge they have overcome the challenges of mental illness to make it happen.

Emily Gibson is a family physician who blogs at Barnstorming.

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  • http://www.kathymorelli.com Kathy Morelli, LPC

    This is truly a great blog post. I worked with the truly lost for many years, those with severe & persistent mental illness (SPM). And often they would go off their meds, wander aimlessly or run away in terror (from something in their own minds), become homeless, dirty , unfed, hide in the woods in the cold winter….cowering….it happened often. And b/c of their civil rights we were unable to stop this until it became a dire situation. What type of compassionate society are we? Does this make sense to you? And there were the one or two who were violent to other people and we were helpless to stop this as well, b/c of their civil rights. it was a tough thing to see.
    And the funding for the programs was so poor that sometimes we didn’t have any office supplies. Again, what type of society are we?

    • http://www.talktoyourunconscious.wordpress.com BobBapaso

      We are a society that denies mental illness, and has therefore dismantled much of it’s treatment infrastructure, both physical and legal.

      We are a society that denies death, and therefore does not protect ourselves from it, whether caused by mental illness, high fructose corn syrup, or contagious disease.

      • http://www.kathymorelli.com Kathy Morelli, LPC

        Hi Bob – so true. Big healthcare insurance companies are in the process of dismantling mental health care even more. It’s unbelievable what goes on when trying to get authorizations for clients for their care. I dont; know, I just pay my painters & plumbers at the time they do their work, and I dont have a review board take a look at it first.

  • Craig Brenner

    Interestingly, it would seem that the college and graduate school system might be a good place to discover any inherent mental health concerns and bring treatment to the student. Sadly, there appears to be little that ensures that a student must get the therapy and assistance that is needed. When a student drops out of school, he or she is essentially lost to the supervision and observation of others who may be able to steer him or her to a mental health care situation. Perhaps an idea, though certainly a big brother type of scenario, might be to mandate that all students matriculating to higher education agree upon matriculation that they will comply with university mental health recommendations as a means of being accepted into their schools. This way, noone would be lost to follow up and proper treatment can be administered. I would think this could be university policy or even if need be, law enforced. This only makes sense and would keep any serious situation from being lost to follow up until dare we say it becomes destructive to a higher proportion.

  • http://www.kathymorelli.com Kathy Morelli, LPC

    Just wanted to add that around 16, 17 or early college age is the developmental period when a schizophrenic break may occur in a lifetime. So it would appear this is a good time for assessment. But assessment occurs and the law protects an individual’s civil rights, I think at the safety of the greater good of society. I am not saying that ppl should be denied civil rights, but maybe there could be some sort of modifications made to the law in light of what we have learned?

  • jsmith

    There are plenty of college students now who are so mentally ill that without family support and meds, they would be homeless. In the 60s they would be in state mental hospitals. We’re not talkin’ a little depression or anxiety.
    But college administrators take no notice of this when deciding on admissions. It comes down to the college health docs. If there is no college health service or a skeletal one, it sometimes comes down to the local MH services or the police.

  • http://www.therextras.com/therextras/2010/12/having-choices-is-wonderful.html Barbara Boucher, PT,PhD,OT

    “the primary mission of an institution of higher learning is not to be a residential psychiatric treatment center, but this level of care often is expected by students and their families, and this week, this opinion was echoed by a chorus of media pundits, bloggers and commenters.”

    The push for more medical care provision by educational entities, including K-12, has been occurring for at least 30 years. With each incident of this type, the cry for more personal oversight by higher education increases in volume.

    “there are times when the student simply can’t remain in the classroom, yet won’t cooperate with seeing a psychiatrist, and is not impaired enough for the state to go through commitment proceedings.”

    I can see how this might be missed by the large part of society that do not deal with mental illness on any level. Is there an organization, appropriate physician ‘academy’ that could make this point more prominently, ‘increasing awareness’?

  • gzuckier

    I recall that one of my college-mates was not only schizophrenic, but also had a hit list of individuals he intended to kill someday, which was being constantly updated. At the time we all laughed it off, but looking back it from this vantage point, I shudder.

  • supermom2

    I’m wondering why the parents of Mr. Loughner were not trying harder to get their son some help. Did they look at his on-line postings? Their son was living with them yet they took no notice of his extracurricular activities? I understand that he was legally an adult, but when school officials come to your home to announce that your son is too mentally unstable to be allowed to attend, shouldn’t you try to take some action? I do blame the parents for doing nothing. I am a parent and I do take my children’s mental health seriously. Every parent should. Sadly, these parents did not.